title: Determinants of microvascular damage recovery after acute myocardial infarction: results from the acute myocardial infarction contrast imaging (AMICI) multi-centre study.
abstract: OBJECTIVE
  Microvascular damage (MD) occurring soon after primary percutaneous coronary intervention (PPCI) may reverse or remain sustained within the first week after ST-elevation myocardial infarction (STEMI). We investigated the incidence, determinants, and long-term clinical relevance of MD reversal after PPCI.
  
  
  RESULTS
  Serial two-dimensional echocardiograms (2DE) and a myocardial contrast study were obtained within 24 h of PPCI (T1) and at pre-discharge (T2) in 110 successfully re-perfused STEMI patients. Six months 2DE and 2-year clinical follow-up were obtained. After PPCI myocardial re-perfusion was normal at T1 only in 40 patients (36%, 'normal reflow'), recovered at T2 in 33 (30%, 'reversible MD'), and remained abnormal in 37 (34%, 'sustained MD'). At follow-up, normal reflow and reversible MD were coupled with a significant reduction in the infarct area, decrease in cardiac volumes, and a slight non-significant improvement in systolic function. Conversely, in the sustained MD group, the infarct area did not change and cardiac volumes significantly increased with a parallel worsening in systolic function. By multivariate analysis, independent predictors of reversible MD were: absence of family history of coronary artery disease (CAD), younger age, shorter time to re-perfusion, and absence of diabetes. The 2-year combined events rate was significantly lower in reversible MD (log-rank test P= 0.03) compared with sustained MD patients.
  
  
  CONCLUSIONS
  In STEMI patients treated according to the current guidelines, MD frequently occurs soon after re-perfusion but it is reversible in ~50% of cases and it is associated with a favourable functional and clinical outcome. Family history of CAD, aging, time to re-perfusion, and diabetes are independent predictors of MD reversibility.
authors.affiliation: Department of Cardiology, Catholic University of the Sacred Heart, Campobasso, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Funaro
authors.forename: Leonarda
authors.initials: L
authors.lastname: Galiuto
authors.forename: Francesca
authors.initials: F
authors.lastname: Boccalini
authors.forename: Sara
authors.initials: S
authors.lastname: Cimino
authors.forename: Emanuele
authors.initials: E
authors.lastname: Canali
authors.forename: Francesca
authors.initials: F
authors.lastname: Evangelio
authors.forename: Laura
authors.initials: L
authors.lastname: DeLuca
authors.forename: Lazzaro
authors.initials: L
authors.lastname: Paraggio
authors.forename: Antonella
authors.initials: A
authors.lastname: Mattatelli
authors.forename: Lucio
authors.initials: L
authors.lastname: Gnessi
authors.forename: Luciano
authors.initials: L
authors.lastname: Agati
mesh_terms: D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D003287:Contrast Media; D003326:Coronary Circulation; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate
chemical_list: D003287:Contrast Media; D019039:Platelet Glycoprotein GPIIb-IIIa Complex